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Primary Contact: Alastair Bax

Phone: +64 21 0421146
eMail:

Emergency Contact/Web Site Tech: Cliff Field

Phone: +64 27 4079233

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Title

Message

Mission Log

The record shown below failed to import. Fields that caused the error have input controls (text boxes or drop downs etc) displayed to enable the error to be corrected.

When finished entering the correct values, click the "Import Now" button to attempt to import the record again.

Provider:		Base:
Incident/Mission #:		Date of Service:
Time Dispatched:		Day/Night:
Activation Time (Sec.):		Activation Time Mins.:
Activation Time Commentary:		Flying Time (RIM Hours):
Aircraft Reg. #:		Type Of Mission:
Agency:		Service Item Code:
Priority:		Description:
Pick Up Loc.		Drop Off Loc.
Patient Outcome:		Activation Time Day (Sec.):
Activation Time Night (Sec.):		Month:
Calendar Year:		Financial Year:
Quarter:		Value:
Time Job Completed:		Mission Notes:
Where do they Reside?
Quality of Dispatch		How And/Or Why?
Did Air Desk Add Value?		How And/Or Why Notes

User Details

To edit the details of this user, make changes in the fields below, then click the save button.

UserName:		Password:
Email:		Client
Is Site Admin User:		Is Client Admin:
Is ARG Chairman:		Expiry Date:

User Details

To edit the details of this user, make changes in the fields below, then click the save button.

UserName:		Password:
Email:		Operator
HEMS Admin:		HEMS Users:
HEMS DropDowns		HEMS View:
HEMS Add:		HEMS Edit:
HEMS Delete:		HEMS Reports:
		Expiry Date:

Medical Record User Details

To edit the details of this user, make changes in the fields below, then click the save button.

UserName:		Password:
Email:		Client
Is Client Admin:		Add Records?:
Modify Company Details?:		Delete Records?:
View/Run Reports?:		Modify Records?:
Modify Dropdown Lists?:		Expiry Date:

Client Details

To edit the details of this client, make changes in the fields below, then click the save button.

Client Name:		Address:
Phone:		Fax:
Email:		Web:
Contact Person:		Second Contact (If Any):
Provider Name:		The Provider Name must be an exact match to the name used in the spreadsheets when importing Mission Logs for this Client/Provider.
Logo Image:		Please add the client first - then edit to add an image.

MEDICAL FLIGHT RECORD

Date:

Patient Category Patient Acuity

Time Period:

Patient Hospital Number:

Patient Name:

DOB:

ACC: ACC Number:

Within 24hrs?

Gender:

DHB of Domicile:

Age:

Relative Travelling:

Transported From:

To:

Fixed Wing:

Helicopter:

Ground Transport Only:

Crew Configuration:

Crew Name 1:

Name 2:

Name 3:

Name 4:

Transfer Reason:

Elective/Urgent

Type of Patient:

Lines and Monitoring:

	In Situ	Inserted By Team
Nasogastric Tube
Urinary Catheter
IV Line
CVC
Arterial Line
Intubated
Tracheostomy
Intercostal Drain	L R	L R

In-Flight:

Pulse Oximeter	ECG	NIBP	Arterial Line	Oxygen
CVC	Ventilator	ETCO2	CPAP/BiPAP	Vacuum Mattress
Infusions:
GTN	Adrenaline	Dopamine	Other

Intervention During Flight:

Drugs

New Fluids

Blood/Blood Products

Other

Times:

Call Received: - :

Is this a night flight?

Take Off: - :

Is there more than one patient?

Patient Met: :

Is the patient backloaded?

Patient Uplifted: :

Arrival at Receiving Hospital: :

Handover Completed: :

Mission Completed: :

Comments:

Were there any problems transporting this patient?
If so, see comments section.

Sorry, but we cannot load this medical record. It may be that you don't have permission to view it, or an incorrect ID might have been provided to this form.

MODIFY MEDICAL FLIGHT RECORD

Minimum information required to add a record is Date Of Service, First Names and Last Name (more data can be added later).

Date of Service:

Patient Category: Patient Acuity:

Time Period:

Patient Hospital Number:

First Name(s): Last Name: DOB:

ACC: ACC Number:

Within 24hrs?

Gender:

DHB of Domicile:

Male Female

Age:

Years Months

Relative Travelling

Transported From:

To:

Fixed Wing:

Helicopter:

Ground Transport Only:

Crew Configuration:

Crew Name 1:

Name 2:

Name 3:

Name 4:

Transfer Reason:

Elective/Urgent

Elective Urgent

Type of Patient:

Details of 'Other':

Lines and Monitoring:

	In Situ	Inserted By Team
Nasogastric Tube
Urinary Catheter
IV Line
CVC
Arterial Line
Intubated
Tracheostomy
Intercostal Drain	L R	L R

In-Flight:

Pulse Oximeter	ECG	NIBP	Arterial Line	Oxygen
CVC	Ventilator	ETCO2	CPAP/BiPAP	Vacuum Mattress
Infusions:
GTN	Adrenaline	Dopamine	Other

Intervention During Flight:

Drugs

New Fluids

Blood/Blood Products

Other

Times:

Call Received: - :

Is this a night flight?

Take Off: - :

Is there more than one patient?

Patient Met: :

Is the patient backloaded?

Patient Uplifted: :

Arrival at Receiving Hospital: :

Handover Completed: :

Mission Completed: :

Comments:

Were there any problems transporting this patient?
If so, see comments section.

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